Telepractice in speech-language pathology and audiology—and in other health-related fields—is not new, but some payers are lagging behind practitioners in recognizing and reimbursing for services provided remotely.
Interest in telepractice among speech-language pathologistsand audiologists is growing—as indicated by the growing number of affiliates in ASHA's Special Interest Group (SIG) 18, Telepractice. Knowing where reimbursement for telepractice is available can help clinicians decide whether to invest in equipment and training for this method of service delivery.
SLPs and audiologists considering telepractice should consult ASHA's guidance and information and be trained and competent in this form of service delivery. Clinicians can affiliate with SIG 18, ASHA's newest special interest group, to connect with the current resources about telepractice and reimbursement.
ASHA, along with other health-related organizations, continues to advocate with public and private payers for increased telepractice coverage.
Medicare reimbursement policies, which have substantial influence on other payers, have been the biggest barrier to the expansion of telepractice in health care. The original federal legislation on Medicare "telehealth" specified a small group of professionals as eligible providers of telepractice service (physicians, nurses, social workers, psychologists). ASHA appeals to CMS annually and collaborates with other organizations to advocate for legislation that would expand this list to include other providers, including SLPs and audiologists.
Private Health Plans
Telepractice acceptance is growing among private health insurance companies, which, on their own or through state mandates, are increasingly accepting and reimbursing a variety of health care services delivered remotely. In 2012, for example, three states (Maryland, Michigan, and Vermont; The ASHA Leader, July 3) added telepractice mandates to their state regulations, bringing to 15 the number of states to mandate private payer reimbursement for telehealth (the others are California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas, and Virginia).
In some cases, insurance companies are moving ahead with telepractice coverage on their own. Most recently, officials at CareFirst BlueCross BlueShield in the mid-Atlantic region have indicated willingness to reimburse telepractice services.
Anecdotal evidence indicates that some insurers without telepractice policies in place have, when notified by providers of their intention to provide telepractice services, accepted and reimbursed these encounters. ASHA recommends that clinicians contact payers in advance to ensure agreement about documentation, coding, and payment of telepractice sessions.
Rural school districts have served as a proving ground for the use of telepractice. These schools, which often deal with shortages of qualified SLPs and long distances between schools, recognize the value of telepractice for their children with communication disorders. The majority of school-based telepractice services are provided by private practitioners who contract with school districts, but some school systems are developing pilot telepractice programs with grants from their state boards of education.
In some local school districts, Medicaid can be an important source of funding for speech-language treatment. As the benefits of telepractice—timely and efficient access to services—are increasingly recognized, Medicaid reimbursement for school-based telepractice is expanding. In 2011, for example, the Virginia Medicaid program specifically added speech-language telepractice (for intervention listed in an individualized education program provided to Medicaid-eligible children at schools) to its list of covered and reimbursed services. Also in 2011, after several successful years of an Ohio grant-funded telepractice program (the Ohio Master's Network Initiative in Education), providers convinced the state Medicaid program to continue to reimburse speech-language intervention services provided through telepractice.
Medicaid, the state- and federally funded program for individuals with limited incomes, is expanding its telehealth (the term Medicaid uses) coverage, largely because the program focuses on access to health care for all eligible residents in a state. Telehealth enhances Medicaid's ability to reach and provide services to people who are geographically, physically, or economically isolated.
Because each state may choose whether to cover telehealth and create its own operational program requirements or restrictions, coverage under Medicaid is very difficult to track. States differ in the providers and patient sites that Medicaid will cover. For example, one state's Medicaid program may cover telehealth services provided by physicians, nurses, and psychologists, but not those provided by ancillary care providers, such as SLPs. Also, a program may cover services provided to a student in a school, for example, but not to a stroke patient at home.
Some states' written regulations are so broad that they are interpreted to include nearly all licensed non-physician or ancillary service providers. Providers should always check their state's Medicaid regulations to confirm its telepractice policies.
ASHA has confirmed that the following states reimburse telehealth under Medicaid:
- Maine and Colorado—under broad provisions—cover SLPs.
- California's new law (Chapter 547) reimburses all licensed health care providers.
- Missouri specifically lists SLPs as participating providers.
- Virginia and Ohio cover Medicaid-eligible children in schools.
Many other projects and discussions are taking place around the country, as clinicians advocate with their state Medicaid officials, emphasizing the efficiencies of telepractice and the appropriate inclusion of SLPs and audiologists to serve the unmet needs of people with communication disorders.
For more information, visit ASHA's Telepractice webpage.